Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Palliat Med. 2020 Mar;23(3):337-345. doi: 10.1089/jpm.2019.0334. Epub 2019 Sep 17.
Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Multimethod evaluation of an educational program. In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance ( < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.
在重病患者中，未能发起有关其价值观和目标的讨论仍然是一个普遍存在的问题。许多临床医生在这些讨论方面的培训不足。评估一种新的培训师培训模式是否会产生高质量的培训，从而提高临床医生在重病沟通方面的自我报告能力。对教育项目的多方法评估。2016 年，Ariadne Labs（AL）的三位教员进行了三次培训师培训课程，以使每个机构的教员培训师能够向临床医生教授重病沟通。作为培训后的问卷调查收集的主要评估指标是临床医生在培训后的技能自我报告与培训前相比的变化。次要措施包括课程评估和定性学习。从 2016 年到 2018 年，AL 在三个系统中培训了 22 名培训师（22 名中有 19 名是姑息治疗专家），培训了 297 名临床医生（49%为医生；35%为高级实践临床医生；12%为注册护士、社会工作者或牧师；4.0%为其他）涵盖了多个亚专业领域（48%）；初级保健（28%）；姑息治疗（17%）；和其他（7.1%）。临床医生报告说，有两个系统的所有技能都有统计学上的显著改善，而第三个系统的所有技能都有改善，其中两个达到了统计学意义（ < 0.0001）。参与者高度评价培训质量（95%的人认为非常有效/非常有效），并分享了各种收获，反映了知识、态度和技能的积极转变。通过培训师培训模式提供的重病沟通培训非常受欢迎，并且临床医生的能力自我报告有显著提高。对于寻求培训其临床工作人员的医疗系统来说，这可能是一种可行的方法。
